Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.

Objective:To explore the expression level and clinical significance of serum Hsa_circ_0089761 in patients with cervical cancer.Methods:A total of 107 cervical cancer patients, 80 cervical intraepithelial neoplasia (CIN) patients, and 60 normal control group were selected and analyzed from January 2021 to March 2023 at the Ninth Affiliated People's Hospital of Shanghai Jiao Tong University School of Medicine. We compared the levels of serum Hsa_circ_0089761, squamous cell carcinoma antigen (SCCA), and carcinoembryonic antigen (CEA) among different groups, and analyzed the relationship between the expression level of serum Hsa_circ_0089761 and the clinical and pathological characteristics of cervical cancer. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of serum Hsa_circ_0089761, SCCA, and CEA levels for cervical cancer. Pearson correlation analysis was used to evaluate the correlation between serum Hsa_circ_0089761 expression levels and SCCA and CEA in cervical cancer patients.Results:The expression levels of serum Hsa_circ_0089761[(2.96±0.95) vs (1.83±0.74), (0.92±0.41)], SCCA[(9.63±1.84)ng/ml vs (2.28±0.65)ng/ml, (1.30±0.27)ng/ml], and CEA[(6.47±2.20)ng/ml vs (1.61±0.57)ng/ml, (1.15±0.12)ng/ml] in the cervical cancer group were significantly higher than those in the CIN group and the control group (all P<0.001), and the serum Hsa_circ_0089761 expression levels in the CIN group were significantly higher than those in the control group ( P<0.001). Cervical cancer patients in stages Ⅲ-Ⅳ, with low differentiation, lymph node metastasis, infiltration depth ≥1/2 of the muscle layer, positive SCCA, and positive CEA had significantly higher levels of serum Hsa_circ_0089761 expression (all P<0.05). The ROC curve analysis showed that the specificity of diagnosing cervical cancer was highest (85.00%) for Hsa_circ_0089761 ≥2.25, and the area under the ROC curve (AUC) for diagnosing cervical cancer in combination with SCCA was highest (0.932, 95% CI: 0.874-0.993), with the highest accuracy (89.30%). The sensitivity of the combination of Hsa_circ_0089761+ SCCA+ CEA in diagnosing cervical cancer was highest (96.26%). The correlation analysis results showed that the serum Hsa_circ_0089761 expression levels in cervical cancer patients were positively correlated with SCCA ( r=0.775, P<0.001) and CEA ( r=0.613, P<0.001). Conclusions:The expression level of serum Hsa_circ_0089761 in cervical cancer patients is significantly increased, which is related to clinical and pathological characteristics. The combination of Hsa_circ_0089761 and SCCA detection has high value in the diagnosis of cervical cancer.

Objective To explore the prognostic value of serum interleukin-36(IL-36)family cyto-kines in patients with Guillain-Barre syndrome(GBS).Methods A retrospective trial was conduc-ted on 176 GBS patients admitted to our hospital from December 2020 to January 2023.According to their Hughes score at 6 months'follow-up,they were divided into good prognosis group(n=92)and poor prognosis group(n=84).Their general data were collected,and the levels of IL-36 family cytokines,such as IL-36α,IL-36β,IL-36γ and IL-36Ra were detected.Multivariate logistic regression analysis was employed to identify the influencing factors for poor prognosis of GBS patients,and ROC curve was plotted to analyze the predictive values of related factors.Results There were significant differences in age,injury types by electromyography(EMG),length of hospital stay and respiratory assisted ventilation between the two groups(P＜0.05,P＜0.01).The levels of IL-36α,IL-36β and IL-36γ were obviously higher while that of IL-36Ra was notably low-er in the poor prognosis group than the good prognosis group(P＜0.01).Multivariate logistic regression analysis showed that age,respiratory assisted ventilation,EMG injury types(myelin sheath and axon are damaged),and serum IL-36γ and IL-36Ra levels were independent influen-cing factors for poor prognosis of GBS patients(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of IL-36γ,IL-36Ra and their combination was 0.674(95％CI:0.599-0.742),0.862(95％CI:0.80 3-0.910)and 0.888(95％CI:0.832-0.931),respectively.Calibration positive curve analysis showed that the combined model of IL-36γ and IL-36Ra levels presented good con-sistency with the actual risk in predicting the risk of poor prognosis in GBS patients.Conclusion Age,respiratory assisted ventilation,EMG injury types(myelin sheath and axon are damaged),and IL-36γ and IL-36Ra levels are independently risk factors for poor prognosis of GBS patients.The combination of IL-36γ and IL-36Ra levels has a good predictive value for poor prognosis of GBS patients,and can be used as an effective indicator for the prediction.

Objective To investigate the value of multi-slice spiral CT enhanced scanning combined with CT texture analysis in preoperative International Federation of Gynecology and Obstetrics(FIGO)staging of ovarian cancer.Methods A total of 126 ovarian cancer patients admitted to the Tongzhou District Maternal and Child Health Hospital and Beijing Friendship Hospital,Capital Medical University from March 2021 to September 2023 were selected as the research subjects.All patients underwent multi-slice spiral CT enhanced scanning,and their CT values were measured.Kinetics software was employed for CT texture analysis,and the texture feature-related parameters,including skewness,kurtosis,variance,entropy,and inverse difference,were calculated.The CT values and CT texture feature-related parameters among patients with different FIGO stages were compared.The diagnostic efficacy of CT enhanced scanning,CT texture analysis,and their combination in preoperative FIGO staging of ovarian cancer was evaluated by receiver operating characteristic(ROC)curve,and the consistency between the diagnosis of FIGO stage of ovarian cancer based on CT enhanced scanning,CT texture analysis,and their combination and the pathological diagnosis of FIGO stage of ovarian cancer was evaluated by Cohen's Kappa coefficient analysis.Results The CT value and entropy value of FIGO stage Ⅳ patients were significantly higher than those of FIGO stage Ⅰ,Ⅱ,and Ⅲpatients,and the CT value and entropy value of FIGO stage Ⅲ patients were significantly higher than those of FIGO stage Ⅰand Ⅱ patients(P＜0.05);there was no statistically significant difference in the CT value and entropy value between FIGO stage Ⅰ and stage Ⅱ patients(P＞0.05).There was no statistically significant difference in skewness,kurtosis,variance,and inverse difference among patients with different FIGO stages(P＞0.05).The ROC curve analysis showed that with reference to FIGO stages Ⅰ and Ⅱ,when the cut-off values of CT value and entropy value were 74.645 and 9.540,respectively,the area under the curve(AUC)of CT value and entropy value in diagnosing FIGO stage Ⅲ was 0.733 and 0.743,respectively,the specificity was 0.760 and 0.800,respectively,and the sensitivity was 0.605 and 0.674,respectively;the area under the curve(AUC)of CT value combined with entropy value in diagnosing FIGO stage Ⅲ was 0.818,the specificity was 0.820,and the sensitivity was 0.721.When the cut-off values of CT value and entropy value were 77.095 and 10.020,respectively,the AUC of CT value and entropy value in diagnosing FIGO stage Ⅳ was 0.817 and 0.797,respectively,the specificity was 0.820 and 0.820,respectively,and the sensitivity was 0.545 and 0.667,respectively;the AUC of CT value combined with entropy value in diagnosing FIGO stage Ⅳ was 0.926,the specificity was 0.900,and the sensitivity was 0.758.The consistency between CT enhanced scanning and pathology in diagnosing FIGO stage of ovarian cancer was moderate(Kappa=0.580,P＜0.05),with an accuracy rate of 72.22％(91/126);the consistency between CT texture analysis and pathology in diagnosing FIGO stage of ovarian cancer was moderate(Kappa=0.598,P＜0.05),with an accuracy rate of 73.81％(93/126);the combination of CT enhanced scanning and CT texture analysis in the diagnosis of FIGO stage of ovarian cancer had a high consistency with pathological diagnosis(Kappa=0.868,P＜0.05),with an accuracy rate of 91.27％.Conclusion Multi-slice spiral CT enhanced scanning and CT texture analysis are both reliable methods for the diagnosis of FIGO stage of ovarian cancer.The combination of CT enhanced scanning and CT texture analysis in the diagnosis of FIGO stage of ovarian cancer has a high consistency with pathological diagnosis.The combination of the two can improve the diagnostic efficiency for FIGO stage of ovarian cancer.

Objective:To analyze the experiences and practice in the reform of public hospital salary system in Sichuan province, summarize the typical modes of such reform in the province, and provide references for further reform.Methods:As of October 29, 2021, the research group received 77 sets of typical experience materials submitted by the health commissions and public hospitals in Sichuan province on enforcing the reform of the public hospital salary system. The analysis framework was based on the five main elements proposed in the Guidance to Deepening the Reform of the Salary System of Public Hospitals for the purpose of furthering the reform. These five elements refer to " reasonably determining the level of salary in public hospitals" " fully implementing the autonomy of internal distribution in public hospitals " " establishing and improving the incentive and restraint mechanism for the remuneration of public hospital leaders" " improving the assessment and evaluation mechanism oriented to public welfare" and " funding sources ". A quantitative analysis was made on the typical experience materials using the social network analysis method, while a qualitative analysis was made on the typical experience materials using the content analysis method. Results:The results of social network analysis showed that the network density was 0.272; the highest point centrality was " fully implement the autonomy of internal distribution in public hospitals" (0.935), and the highest intermediary centrality was " improving the assessment and evaluation mechanism oriented to public welfare" (0.870), while the closeness to centrality of " establishing and improving the incentive and constraint mechanism for the salary of public hospital leaders" (0.434) and " funding sources" (0.421) were relatively low. The results of content analysis showed that the ones with higher frequency among all the typical experience materials were " fully implementing the autonomy of internal distribution of hospitals" (72 times) and " improving the assessment and evaluation mechanism oriented to public welfare" (67 times), while the ones with lower frequency were " establishing and improving the salary incentive and constraint mechanism for public hospital leaders" (17 times) and " funding sources" (14 times). In terms of unity and synergy, the typical models of public hospital salary system reform in the province could be categorized as the fine standard mode, the fair value mode, the autonomous synergy mode and the circular symbiosis mode.Conclusions:Deepening the reform of the salary system of public hospitals should unify the standards and improve the fair and refined assessment and evaluation mechanism; explore various forms of distribution and build an internal autonomous and synergistic incentive mechanism; pay attention to the weak remuneration incentive mechanism for hospital leaders and the problem of a relatively single source of funding.

Objective:To analyze the salary characteristics of medical institutions and the influencing factors of personnel expenditure as found in the salary system reform of public hospitals in Sichuan province, for reference in furthering such reform in public hospitals.Methods:The data of personnel expenditure, business operation and medical services came from 96 medical institutions in 21 cities(prefectures)of Sichuan province from 2017 to 2020 by means of institutional survey. The average salary level and salary structure of medical staff were used to describe the salary characteristics, and the total salary was presented by the level of personnel expenditure. The measurement data was represented by M(IQR), the counting data was described by frequency and constituent ratio, and the influencing factors of personnel expenditure were analyzed by generalized linear mixed model. Results:From 2017 to 2020, the personnel expenditure of medical institutions increased by 13.04% annually. In 2020, the per capita salary level of medical staff was 151 900 yuan, while the basic salary and performance salary accounted for 16.20% and 54.60% of personnel expenditure respectively. The analysis results of the generalized linear mixed model showed that the average cost of patients per visit( β=0.596), the level of drugs and sanitary materials consumed per 100 yuan medical income( β=0.286), the number of medical visits( β=0.328), and the years [(2018, 2019, 2020) β=0.025, 0.052, 0.066] were positively correlated to personnel expenditure, while the average length of stay( β=-0.693), the proportion of medical service income( β=-0.392), and the balance rate of income and expenditure( β=-0.062)were negatively correlated to personnel expenditure( P<0.05). The proportion of fiscal subsidy revenue, regional GDP and asset-liability ratio were not the influencing factors of personnel expenditure( P> 0.05). Conclusions:In the reform of the salary system of the province, its salary level of medical institutions has surpassed the current wage ceiling of these institutions. As the salary distribution was mainly made based on the workload, the " baton" role of the salary system reform has begun to pay off. However, the basic guarantee role of compensation has not yet been fully leveraged.Further reform is needed in upgrading refined management, and timely dynamic adjustment of personnel expenditure in combination with the hospital's financial performance and cost analysis, and reasonably optimizing the level of medical staff compensation.

Objective:To analyze the staff salary status and the influencing factors in traditional Chinese medicine(TCM) hospitals implementing the salary system reform in Sichuan province in 2020, for reference in optimizing the salary system reform of such hospitals.Methods:Cluster sampling and institutional survey were used to collect the salary information of 26 TCM hospitals in 21 cities(prefectures)of Sichuan province implementing the salary system reform in 2020. Such information was then subject to descriptive analysis, while the influencing factors of salary were subject to one-way analysis of variance and generalized linear model multifactor analysis.Results:15 428 staff from 26 TCM hospitals were included as the research objects. In 2020, personnel expenditure accounted for 40.23% of the total expenditure, and 24.34% of which came from financial subsidy in 26 TCM hospitals. The average annual payable income per person was(149 312±74 288)yuan, 67.82% of which being performance pay. Analysis of variance showed that there were significant differences among the salary levels of staff in different economic regions, hospital grades, hospital levels, gender, educational background, position, seniority, performance pay ratio, employment in the government system and other natures, senior and other professional titles, doctors and other positions( P<0.05), and the differences were still statistically significant after adjustment by generalized linear model( P<0.05). Conclusions:The reform of the salary system of Sichuan TCM Hospitals has basically achieved equal pay for equal work, and the income of low-level personnel has been improved. However, the salary level was not very motivated and the salary structure was not guaranteed. It is necessary to strengthen financial precision subsidies, increase the proportion of personnel expenditure, so as to support the increase of the absolute value of salary in non-core economic areas, improve the salary structure, reasonably widen the salary gap among different educational backgrounds and positions, further optimize internal distribution, and ensure the sustainable development of Chinese medicine talents.

Objective:To analyze the epidemiological and clinical characteristics of imported COVID-19 cases after SARS-CoV-2 vaccination and to provide evidence for the prevention and control of COVID-19.Methods:The imported COVID-19 cases in Chengdu as of April 15, 2021 were divided into the vaccinated group and unvaccinated group according to the history of SARS-CoV-2 vaccination. The epidemiological and clinical data of the cases were collected retrospectively, and the differences in epidemiological and clinical characteristics of the two groups were compared. Laboratory tests consisted of nucleic acid test, clinical index test, serum antibody test and lymphocyte test. Software WPS2019 was used for data management and software R 4.0.3 was used for statistical analysis.Results:A total of 75 COVID-19 cases were included in the analysis, in which 20 had received SARS-CoV-2 vaccination and only 4 with clinical symptoms, 55 patients did not receive SARS-CoV-2 vaccination, and 16 had clinical symptoms. In vaccinated group, the first injection time of vaccination ranged from July to November 2020, and 10 cases received two doses of vaccine simultaneously and 10 cases received two doses of vaccine at intervals of 14-57 days. The intervals between the completion of vaccination and the onset ranged from 87 days to 224 days. The differences in classification and clinical type between the two groups were significant. Significant differences were observed in case classification and clinical type between vaccinated group and unvaccinated group ( P<0.05). The vaccinated group had a relatively high proportion of asymptomatic infections (40.00%, 8/20), while mild infections were mainly observed in the unvaccinated group(76.36%,42/55). The differences in Ct values (ORF1ab gene and N gene) at the diagnosis were not significant between vaccinated group and unvaccinated group ( P>0.05), similar results were also observed in lymphocyte subtypes, procalcitonin and C-reactive protein level comparisons. Serum amyloid A level was higher in unvaccinated group than in vaccinated group ( P<0.05). However, the SARS-CoV-2 related serum antibody of IgM, IgG and total antibody levels were significantly higher in vaccinated group ( P<0.05). Conclusions:Risk of infection still exists with SARS-CoV-2 after vaccination, which can facilitate the production of specific serum antibody of IgM and IgG when people are exposed to the virus. It has a certain protective effect on SARS-CoV-2 infected persons. Vaccination can reduce the clinical symptoms and mitigate disease severity.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Objective:To estimate the burden of hip fractures and related factors among the Chinese middle-aged and elderly population.Methods:Based on the data of China Health and Retirement Longitudinal Study (CHARLS) in 2015, the burden of hip fractures among Chinese middle-aged and elderly population was evaluated as the years lived with disability (YLD) rate. The relationship between gender, age (45-49, 50-59, 60-69 and ≥70 years old), educational level (no education, elementary school, junior high school, high school and above), region (urban, rural), gross domestic production (GDP) per capita (low, medium and high) and geographic area (northern, eastern, south-central, northwest and southwest regions) and the YLD rate of hip fractures were analyzed, respectively.Results:Excluding items with missing basic information and hip fracture data, a total of 17,830 subjects (8,405 males and 9,425 females) were included in the study with average age 61.6±9.8 years (range 45 to 105 years). The average age in male was 61.9±9.6 years, and that in female was 61.2±10.1 years. The prevalence of hip fractures was 2.3% (410/17,830). The total YLD rate was [694/100,000 (95% Uncertainty Interval ( UI): 462/100,000, 989/100,000)]. The YLD rates were similar between male [693/100,000 (95% UI: 461/100,000, 988/100,000)] and female [696/100,000 (95% UI: 463/100,000, 992/100,000)] subgroups. The YLD rate of hip fractures was increasing with age, which reached at maximum of 1,155/100,000 (95% UI: 769/100,000, 1,646/100,000) for participants aged 70 years or above. The rate was gradually decreased with the upgrade of the educational level. The participants with high school education and above reached the lowest of 434/100,000 (95% UI: 289/100,000, 619/100,000). In addition, the YLD rate of hip fractures in rural areas [721/100,000 (95% UI: 480/100,000, 1,027/100,000)] was higher than that in urban areas [650/100,000 (95% UI: 433/100,000, 926/100,000)]. The YLD rate in areas with higher GDP per capita [545/100,000 (95% UI: 363/100,000, 777/100,000)] was lower than that in areas with lower GDP per capita [761/100,000 (95% UI: 506/100,000, 1,084/100,000)]. Moreover, the participants living in the Northwest region were with the highest YLD rate of hip fractures [1,056/100,000 (95% UI: 703/100,000, 1,506/100,000)], followed by the Southwest region [887/100,000 (95% UI: 590/ 100,000, 1,264/100,000)] and the Northeast region [317/100,000 (95% UI: 211/100,000, 452/100,000)]. Conclusion:Hip fractures exerted heavy burdens on the Chinese middle-aged and elderly population. The YLD rate of hip fractures varied according to geographical regions, greater age, rural areas, low educational levels and low GDP per capita. These related factors could affect the disease burden of hip fractures in China.